Using your Extended Health Coverage

ICBC will expect you to access your extended health plan first before they pay anything

Many individuals avoid using their extended health coverage when they have an ICBC claim on the basis that they may need to access the plan for unrelated treatment and expenses and do not want to go beyond the maximum allowed under the plan. Unfortunately, this is not in keeping with the law. The reason being, ICBC will expect you to access the extended health plan first before they pay anything under Part VII. Hence, you will have to use the plan to get upfront coverage of expenses.

In accidents before May 17, 2018, ICBC is generally not allowed to deduct payments by the extended health carrier so they end up paying for the full expenses at the end of the claim despite the same expenses already being covered by the extended health carrier. All you need to show is you paid part or all the premiums of the extended health plan, the extended health carrier is pursuing a right of subrogation (i.e. repayment), or the plan is part of your negotiated employment package. In those three instances, which cover most situations, ICBC has no right to deduct the extended health carrier payments.

More and more extended health carriers are now looking to get paid back the expenses they covered through their right of subrogation. If the extended health carrier does not pursue subrogation, you may be entitled to double recovery for the expenses, once from the extended health carrier and once from ICBC.

As noted above, often the extended health carrier is looking to apply their right of subrogation. Do not sign any agreement unless you confirm they have the right in the contract of insurance and that their entitlement only is for the net amount you receive from ICBC after paying legal fees. You do not want to pay back the extended health carrier more than you recovers from ICBC.

For accidents after May 17, 2018, the system has changed in favor of ICBC. You must now exhaust funding from private insurance sources or from government assistance programs before ICBC is required to step in and cover any treatment expenses and medication costs. ICBC can deduct from your tort/injury claim all benefits that you were paid or should have been paid if you had applied. Therefore, you cannot simply ignore the fact that you have an extended health plan. You must use it fully.

ICBC has also legislated away the right of subrogation of the private insurance companies. In turn, the private insurance companies are not accepting this new change in legislation and are still pursuing their subrogation rights by requiring claimants to sign subrogation agreements.

This approach is placing the claimant into a very difficult position. Basically, ICBC does not have to pay for any medical expenses that should be covered by the extended health plan, so the claimant will not receive any money in his/her pocket to pay back the private insurance company. However, the private insurance company still wants to get paid back so the claimant is caught in the middle and may end up having to pay money to the private insurance company that he/she never received from ICBC. Clearly, it is the claimant that is the victim of this dispute between ICBC and the private insurance companies.

The other approach taken by private insurance companies is to deny payment of any medical expenses on the basis that the policy of insurance excludes payments resulting from the negligence of a liable third-party. Technically, because the benefits are not “payable”, ICBC becomes the primary insurer for the benefits and must pay the medical expenses. It remains to be seen what ICBC will do to counteract this new approach.

In summary, maximize your use of your extended health plan. Be very cautious about signing any subrogation agreement in favor of the private insurance company.